Healthcare Provider Details

I. General information

NPI: 1003903188
Provider Name (Legal Business Name): ERIK J. KOBYLARZ MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE DEPT. OF NEUROLOGY, DARTMOUTH-HITCHCOCK MEDICAL CENTER
LEBANON NH
03756-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE DEPT. OF NEUROLOGY, DARTMOUTH-HITCHCOCK MEDICAL CENTER
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-6118
  • Fax: 603-650-6233
Mailing address:
  • Phone: 603-653-6118
  • Fax: 603-650-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number14967
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number14967
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14967
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: